ABSTRACT
Subfascial endoscopic perforating vein surgery is a safe method for the division of incompetent perforating veins. Nevertheless, we report two cases with unfortunate complications: the posterior tibial artery and tibial nerve were damaged during the procedures. In one patient this resulted in a reintervention, but in both patients it resulted in permanent discomfort. We then present a guideline that may prevent damage to these critical structures.
Subject(s)
Angioscopy/adverse effects , Leg/blood supply , Varicose Veins/surgery , Veins/surgery , Humans , Male , Middle Aged , Postoperative Complications , Tibial Arteries/injuries , Tibial Nerve/injuriesABSTRACT
PURPOSE: To quantify the error introduced by noncoaxial intravascular ultrasound (IVUS) imaging and to evaluate the use of a balloon-tipped catheter in compensating for intraluminal angulation and subsequent dimensional inaccuracy. METHODS: The effect of noncoaxial IVUS imaging was investigated in both a polyvinyl chloride phantom and an in vitro canine aorta using a calibrated setup to measure angulation off axis. Imaging was performed at increasing angulation (creating an elliptical image) in both phantoms, with the transducer centered and off center. Diameters were compared to the original coaxial diameter, as well as calculated diameters based on specific angles off axis. The percentage change (error) was also calculated at these angles. The measurements were repeated using a balloon-tipped catheter to center the transducer. RESULTS: The measured diameters and percentage changes compared closely with their calculated counterpart. Up to 25 degrees off axis, the apparent increase in diameter measurement was nearly 10%. Angulation from 30 degrees to 70 degrees resulted in an increase of 15% to 192%. Use of the centering balloon reduced the amount of error by 70% to 85% but was limited to angles < or = 25 degrees due to the design of the test apparatus. CONCLUSIONS: The error introduced by noncoaxial IVUS imaging can be significant and may be partially corrected by the use of a centering balloon. Further studies in the clinical application of a centering device are warranted.
Subject(s)
Phantoms, Imaging , Ultrasonography, Interventional , Animals , Catheterization , Dogs , Mathematics , Observer Variation , TransducersABSTRACT
This study evaluated deployment mechanics and long-term healing of an endoluminally placed stent/graft in normal canine aortas. The endoluminal graft (ELG) consisted of a 8.5 cm segment of expanded polytetrafluoroethylene (ePTFE) graft material (Impra, Inc., Tempe, AZ) encapsulating a series of six Palmaz P-128 stents (Johnson & Johnson Interventional Incorporated, New Brunswick, NJ) along the length of the graft. The prostheses were deployed via the femoral artery using a 14Fr delivery system that contained a balloon catheter to expand the ELG in the infrarenal aorta. Twenty-one prostheses were deployed and evaluated at 1 week (n = 3), 1 month (n = 3), 3 months (n = 3), 6 months (n = 9), and 1 year (n = 3). Dimensions of the infrarenal aorta were determined with intravascular ultrasound (IVUS) and angiography prior to deployment of devices. Real-time fluoroscopy and IVUS were used to monitor device deployment with both imaging modalities repeated following implantation. Gross inspection and microscopic evaluation was performed on the explanted specimens following in vivo evaluation by CT scan, IVUS, and angiography prior to retrieval of the specimens. The prostheses were easily deployed from the femoral access site. Oversizing of the deployment balloon compared to the aortic diameter was necessary to accommodate the 10% device recoil observed following balloon deflation, however, all devices were seated against the aortic wall as evidenced by IVUS. At explant, all devices ware widely patent with limited luminal thrombosis observed in four specimens (19%). Devices were well-incorporated by cellular ingrowth into the ePTFE with the formation of neointima. No device migration or postdeployment recoil was observed. ePTFE graft material between stents protruded slightly into the vessel lumen accounting for a 10% luminal reduction. Fully supported ELG's consisting of balloon expandable stents encapsulated in ePTFE are easily deployed using a low-profile delivery system. Specimens demonstrated uniform long-term patency and healing up to 1 year in a canine aortic model. Those preliminary findings support further study of this fully supported prosthesis in the treatment of arterial disease.
Subject(s)
Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Polytetrafluoroethylene , Stents , Angioplasty, Balloon , Animals , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/pathology , Biocompatible Materials , Dogs , Equipment Design , Graft Occlusion, Vascular/diagnosis , Tomography, X-Ray Computed , Ultrasonography, Interventional , Vascular Patency , Wound HealingABSTRACT
This study investigated remodeling in human coronary arteries with intravascular ultrasound. We conclude that regression analysis performed by Glagov et al and adopted by others is reproducible but is unable to discern shrinkage of the vessel area.
